How to Reveal Disguised Paternalism – Version 2.0

Objectives: To further develop an index for detecting disguised paternalism, which might influence physicians’ evaluations of whether or not a patient is decision competent at the end of life. Disguised paternalism can be actualized when physicians transform hard paternalism into soft paternalism by denying the patient’s decision-making competence. Methods: A previously presented index was further developed to make it possible to distinguish between high and low degrees of disguised paternalism using the average index of the whole sample. We recalculated the results from a 2007 study to compare to a 2020 study. Both studies are about physicians’ attitudes towards, and arguments for or against, physician assisted suicide (PAS). Results: The 2020 study showed that geriatricians, palliativists and middle aged physicians (46-60 years) had indices indicating disguised paternalism, in contrast with the results from the 2007 study, which showed that all specialties (apart from GPs, surgeons and older physicians) had indices indicating high degrees of disguised paternalism. Conclusions: The proposed index for identifying disguised paternalism reflects the attitude of a group attitudes towards physician assisted suicide. The indices make it possible to compare the various medical specialties and age groups from the 2007 study with the 2020 study. Because disguised paternalism might have clinical consequences for the rights of competent patients to participate in decision-making, it is important to reveal disguised hard paternalism, which could masquerade as soft paternalism and thereby manifest in practice.